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January 16, 2009

Where do nephrologists come from?

By Bill Peckham

I received an email last weekend which I took to ask "Why are nephrologists less well paid than other medical specialties?" Not being a nephrologist I'm not really qualified to answer but this being a blog I can say what I know. My correspondent stated that there is a significant pay difference between nephrologists and other specialties. As he said money isn't everything but if you can help people and be well paid or help people and be really well paid, why not be really well paid? I'm not too sure there is much of a general disparity between nephrology and other specialties such as hospitalist and nephrologists are better paid than some specialties. If the bureau of Labor and Statistics tracked nephrologist separately they'd be a top paying healthcare occupation.

He wrote after reading my posts regarding dialysis reimbursement and/or about the low margin business of providing dialysis. I don't think dialysis reimbursement impacts a nephrologist's personal reimbursement. There is a separate fee schedule that Medicare pays to a nephrologist that is based on how often the doc sees the patient in a month. That said if you're taking care of a lot of people on dialysis their predominate insurance will be Medicare, about 75% of the census, with about 10% Medicaid. Generally Medicare and Medicaid pay less than employer group health plans so caring for a lot of people on dialysis creates a unadvantageous payer mix.

The other thing is that being a nephrologist is not just taking care of people on dialysis. A nephrologist's practice would be comprised of a variety of patients, nephrology is a large field. Attending Renal Week (the American Society of Nephrology
meeting) last year drove home to me that dialysis is a small part of
the broad medical specialty of nephrology. I've started tracking Renal Fellows Network and Precious Bodily Fluids for my periodic blog reports and they both cover a lot of ground without spending much time on dialysis.